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NPI Code Detail

MEDICARE: KEANDRE TAYLOR

MEDICARE: KEANDRE TAYLOR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA18760TX
2363A00000XPhysician Assistant1216468TX

General Provider Information

NPI Number : 1851115448
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEANDRE TAYLOR
Provider Business Mailing Address
First Line : 122 W COLORADO BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75208-2382
Country : US
Telephone Number : 214-947-6700
Fax Number : 214-947-6701
Provider Business Practice Location Address
First Line : 122 W COLORADO BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75208-2382
Country : US
Telephone Number : 214-947-6700
Fax Number : 214-947-6701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2024
Last Update Date : 05/19/2026

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Directions to “ KEANDRE TAYLOR ” Practice Location

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